Risk stratification and outreach to hematology/oncology patients during the COVID-19 pandemic
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COMMENTARY
Risk stratification and outreach to hematology/oncology patients during the COVID-19 pandemic Chelsea K. Osterman 1 & Tammy Triglianos 1 & Gary S. Winzelberg 2 & Angela D. Nichols 3 & Julia Rodriguez-O’Donnell 4 & Sharon M. Bigelow 5 & Hendrik van Deventer 3,5 & Hanna K. Sanoff 1,5 & Emily M. Ray 1,5 Received: 9 July 2020 / Accepted: 4 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Cancer patients have many medical and psychosocial needs, which may increase during the COVID-19 pandemic. We sought to (1) risk-stratify hematology/oncology patients using general medicine and cancer-specific methods to identify those at high risk for acute care utilization, (2) measure the correlation between two risk stratification methods, and (3) perform a telephone-based needs assessment with intervention for high-risk patients. Methods Patients were risk-stratified using a general medical health composite score (HCS) and a cancer-specific risk (CSR) stratification based on disease and treatment characteristics. The correlation between HCS and CSR was measured using Spearman’s correlation. A multi-disciplinary team developed a focused needs assessment script with recommended interventions for patients categorized as high-risk by either method. The number of patient needs identified and referrals for services made in the first month of outreach are reported. Results A total of 1697 patients were risk-stratified, with 17% high-risk using HCS and 22% high-risk using CSR. Correlation between HCS and CSR was modest (ρ = 0.41). During the first month of the pilot, 286 patients were called for outreach with 245 contacted (86%). Commonly identified needs were financial difficulties (17%), uncontrolled symptoms (15%), and interest in advance care planning (13%), resulting in referral for supportive services for 33% of patients. Conclusion There is a high burden of unmet medical and psychosocial needs in hematology/oncology patients during the COVID-19 pandemic. A telephone-based outreach program results in the identification of and intervention for these needs; however, additional cancer-specific risk models are needed to improve targeting to high-risk patients. Keywords Risk assessment . Coronavirus . COVID-19 . Malignancy . Quality improvement
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00520-020-05744-y) contains supplementary material, which is available to authorized users. * Chelsea K. Osterman [email protected] 1
Division of Oncology, Department of Medicine, University of North Carolina, 170 Manning Drive, CB 7305, Chapel Hill, NC 27599, USA
2
Division of Geriatric Medicine, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
3
Division of Hematology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
4
Department of Social Work, University of North Carolina, Chapel Hill, NC, USA
5
Lineberger Comprehensive Cancer Center, University of North Carolina, Ch
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